Chest pain when swallowing

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Chest pain when swallowing foods or drinks usually indicates a medical condition related to the esophagus.

Other organs – like the stomach, diaphragm, and muscles – involved in swallowing can also cause chest pain after swallowing.

Pain in the chest when swallowing food or drink

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A great video about swallowing and potential problems. Duration: 3:17.

Common causes of chest pain when you swallow foods or drinks are the following:

  • inflammation of the esophagus
  • stricture in the esophagus
  • Hiatal hernia
  • tear in the wall of the esophagus
  • heartburn or GERD (gastroesophageal reflux disease)
  • motility disorders of the esophagus
  • spasm of esophageal muscles

Health problems in these parts of the body might trigger chest pain when swallowing food and drinks:

Center chest pain when swallowing

Swallowing-related chest pain is most often experienced in the center of the chest.

This is because the esophagus is located here, behind the windpipe and breastbone. Any medical issues with an esophageal origin are likely to trigger symptoms here.

Left & right side chest pain after swallowing

Some people experience chest pain on the left, right, or both sides of the chest after swallowing, but not in the center.

This is not very common, and chances are such pain is not related to the food pipe.

Possible causes are:

  • Costochondritis: the inflammation of the cartilage that connects a rib to the breastbone.
  • Strained chest muscles: not only heavy physical exercises, but severe coughing (e.g. during a respiratory illness) might cause this condition.

Usually eating and swallowing are not the only triggers of chest pain in this case, but coughing or breathing in might also be triggered.

Diagnosing the underlying cause of left or right chest pain when swallowing can be hard.

Upper and middle chest pain when swallowing food and drinks

Achalasia is a motility disorder of the esophagus, characterized by absent peristalsis movements and the inability of the sphincter located at the lower end of the esophagus to relax in response to swallowing food.

This means the esophagus cannot push the food down into the stomach. As a result, food sticks in the esophagus, which might cause irritation, inflammation, or enter back into the mouth.

Typical symptoms are:

  • difficulty swallowing
  • chest pain when swallowing
  • weight loss
  • regurgitation of food into the back of the mouth

Achalasia is a rare condition but might cause both upper and center chest pain when swallowing.

Some symptoms of GERD and achalasia overlap, it is easy to mistakenly think that GERD is the culprit. You need to consult with your doctor for a proper diagnosis.

Stabbing pain in the chest after swallowing

Common causes of stabbing pain in the chest after swallowing:

GERD & swallowing problems

GERD is a condition in which gastric acid and food contents flush back into the food pipe. Sometimes the digestive juices flow up to the back of your mouth, causing a sour taste in the mouth. The sphincter at the lower end of the esophagus does not function properly in this disease.

The most common symptom of GERD is heartburn, a stabbing chest pain after eating, caused by stomach acids irritating the lining of the esophagus.

This pain must be differentiated from chest pain due to angina pectoris or heart attack. Unlike heart issues, this pain specifically occurs after eating and does not radiate to the neck, jaw, left shoulder, and jaw.

Reflux of acid causes swelling of the esophagus, also known as reflux esophagitis. You may feel the following symptoms in reflux esophagitis:

  • difficulty swallowing
  • stabbing chest pain
  • heartburn
  • water brash (increased saliva)

One of the complications of reflux esophagitis is Barrett’s esophagus. In this condition, atypical cells replace normal cells in the mucosa of the esophagus. This condition also leads to stabbing pain in the chest after swallowing and might develop into esophageal cancer.

Stabbing chest pain after swallowing pills

Pills-induced esophagitis is the condition in which swallowed medication gets trapped in the esophagus and leads to inflammation of the esophagus.

Risk factors are:

  • existing esophageal disease
  • too large pill
  • taking medication with a very small quantity of water or without water
  • age above 50
  • swallowing the medicine around bedtime

In the case of pill-induced esophagitis, you may feel these symptoms:

  • sudden retrosternal (behind the breastbone) stabbing chest pain after ingestion of the pill
  • nausea and vomiting
  • the feeling of food getting stuck in the esophagus
  • difficulty of swallowing
  • severe pain when swallowing

Sometimes, the esophagus may perforate and bleed, but this rarely occurs. Consult your doctor in case of bloody vomit, severe pain, stools containing blackish blood, and persistent vomiting.

Chest pain when swallowing cold carbonated drinks

Carbonated drinks cause chest pain because they produce gas bubbles which cause chest tightness or pressure, and shortness of breath after you swallow them.

If the drink is very cold, that might make the esophagus go into spasms (just like any other muscle, the esophagus can also go into spasms), which also causes a sharp chest pain around the center of the chest.

Avoid carbonated drinks in case of chest pain or shortness of breath. Other conditions like tonsillitis, epiglottitis ( inflammation of epiglottis), asthma, chronic obstructive pulmonary disease (COPD) may exacerbate if you take carbonated drinks, causing chest pain and shortness of breath.

However, in most cases, chest pain after swallowing carbonated drinks should go away with time and is not a serious medical condition.

Painful swallowing due to food allergies

Eosinophilic esophagitis is the leading cause of painful swallowing and chest pain due to food allergies.

This condition is an immune-mediated response of eosinophils (type of white blood cells) to food particles and gastric reflux. Eosinophils accumulate in the lining of your esophagus.

While experiencing this condition, the esophagus is inflamed, and its tissues get injured due to the immune-mediated reaction of eosinophils to food. Damaged esophageal lining leads to painful, difficult swallowing, and food gets stuck after swallowing.

Symptoms of eosinophilic esophagitis are:

  • difficult and painful swallowing
  • chest pain after swallowing
  • the feeling of food getting stuck in the esophagus
  • backflush of gastric contents
  • difficulty feeding and swallowing in children
  • vomiting and abdominal pain in children

Eosinophilic esophagitis is associated with the following risk factors:

  • a cold, dry climate
  • spring or fall season
  • asthma, especially ectopic asthma
  • males are more prone to this condition
  • history of anaphylaxis
  • family history

Over-the-counter medications are necessary for the treatment of this condition.

Esophagitis and swallowing pain

Esophagitis is a condition in which the lining of the esophagus gets inflamed, causing pain when you swallow food or drinks.

If left untreated, this condition causes ulcers and scarring of the wall of the esophagus.

Symptoms of esophagitis are:

  • nausea and vomiting
  • extremely painful or difficult swallowing
  • chest pain after swallowing
  • heartburn due to acid reflux

Esophagitis is caused by infection or irritation of the lining of the esophagus:

  • Infectious esophagitis includes bacterial, fungal, or viral infections.
  • Irritation may be due to gastroesophageal reflux disease or heartburn, vomiting, medications such as aspirin, pill-induced, or hiatal hernia.

Foods that increase the risk of esophagitis are:

  • caffeine
  • garlic
  • chocolates
  • hot beverages
  • spicy foods

Esophagitis can be prevented by practicing the following measures:

  • do not sleep immediately after eating
  • do not take large, heavy meals
  • do not smoke
  • avoid spicy foods which contain high content of pepper, nutmeg, and chili powder, causing esophagitis
  • avoid acidic juices and try taking them along with vitamin C

If you follow these measures but your symptoms persist, consult a gastroenterologist for further evaluation and treatment.

Stomach pain after swallowing food

Peptic ulcer disease is a condition characterized by the development of painful ulcers, breaks, or sores in the lining of the stomach. It is the most common cause of pain in the stomach after swallowing food.

Peptic ulcer disease is caused by:

  • Helicobacter pylori bacteria
  • non-steroidal anti-inflammatory drugs (NSAIDs) intake for an extended period
  • stress, and smoking

The protective layer of the gastric mucosa is destroyed in this condition. The stomach produces excessive gastric acid, which damages the lining of the stomach, and ulcers form.

You may feel burning pain between your belly button and breast bone after swallowing food.

You can prevent peptic ulcer disease by following these simple steps:

  • avoid spicy foods
  • avoid alcohol intake
  • avoid smoking
  • be careful about taking pain relievers, NSAIDs are prohibited
  • manage stress and anxiety
  • eat healthy foods

Antacids, proton pump inhibitors, and steroids are most commonly used to treat this condition.

Coughing after swallowing food

Dysphagia is a swallowing difficulty associated with cough and choking after swallowing food and drinks.

Other symptoms of dysphagia are:

  • Regurgitation of food back to mouth, it may come out from nose.
  • Continuous drooling of saliva.
  • The sensation of food getting stuck in your throat.
  • Gurgling sound while eating or drinking.
  • Difficulty breathing.

Possible medical problems that cause dysphagia:

  • gastroesophageal reflux disease
  • carcinoma of the esophagus
  • nervous system diseases like stroke
  • head injury
  • dementia.

Treatment of dysphagia depends on the underlying cause. Patients are provided with speech and language therapies to improve swallowing.

Treatment of dysphagia includes:

Cough and chest pain after swallowing

A possible cause of experiencing coughing and chest pain at the same time after swallowing is aspiration pneumonia.

This condition is caused by accidental inhalation of food particles or liquid drops into the lungs. Bacteria contaminate the lungs after aspiration, which causes symptoms.

Common symptoms of this condition are:

  • painful and difficult swallowing
  • cough after eating
  • wheezing
  • fever approximately after one hour of eating food
  • production of extra saliva
  • shortness of breath

Aspiration pneumonia is a severe condition that needs to be treated as early as possible.

If left untreated, it may lead to complete respiratory failure.

Simple steps to avoid aspiration pneumonia after swallowing are:

  • Eat slowly and chew food properly.
  • Keep a glass of water with you while eating and take small sips after swallowing food.
  • Do not eat while coughing or experiencing shortness of breath.

Final thoughts

GERD or heartburn, esophagitis, food allergy, and asthma may worsen if you are careless about your diet and nutrition, which causes chest pain and shortness of breath after swallowing.

People often experience other symptoms after swallowing, typical issues are coughing and stomach pain.

Follow these steps to avoid all kinds of problems:

  • eat healthy foods
  • take regular exercise
  • never go to bed right after taking meals
  • do not smoke
  • do not drink too much alcohol
  • avoid spicy foods
  • avoid too much caffeine and carbonated drinks
  • try to relieve stress and sort out anxiety issues as early as possible.

This article has been written by:

Dr. Shama Nosheen

Department of Medicine and Surgery,
Nishtar Medical University and Hospital